Co-sleeping with your baby is a lovely way to bond and also a convenient way to feed your baby at night without having to get out of bed. This age old practice of being close to you for warmth and comfort is arguably a natural way for babies to sleep. However, co-sleeping and bed-sharing is a contentious topic, and one that we know sparks a lot of debate.
The American Academy of Paediatrics (AAP) put forward the ABCs of Safe Sleep that advise against co-sleeping and the International La Leche League developed the Safe Sleep 7 to accommodate breastfeeding moms who want to co-sleep. While both perspectives aim to reduce the risk of SIDS, there are fundamental differences between them, which we will expand on in this article.
In this article we will take a look at the current research and evidence available, and empower you with knowledge on the risks of bed-sharing to ensure you make the most informed decision for yourself and your baby.
IS THERE A DIFFERENCE BETWEEN CO-SLEEPING AND BED-SHARING?
Co-sleeping is a term broadly used to describe a baby or child sleeping in the same sleep area as their parent/s. There are generally two types of co-sleeping;
The first is called “room-sharing” which is a term used to describe a baby sleeping in their own cot or sleep space but in their parents’ room or sleep area.
The second type of co-sleeping is called “bed-sharing” which is the term used to describe when a baby or toddler sleeps in the same bed or on the same sleep surface as their parent/s.
WHAT ARE THE AMERICAN ASSOCIATION OF PEDIATRITIAN’S ABC’S OF SAFE SLEEP?
The introduction of the Safe to Sleep Campaign assisted in dramatically decreasing the number of babies lost to SIDS. Initially, their main drive was “Back to Sleep” and encouraged parent’s to place their babies on their backs when sleeping as this is proven to be safest. It was later expanded to the ABC’s of safe sleep.
Your baby should always be
Alone, on their Back and in their Cot.
A IS FOR ALONE
The AAP encourages sharing a room with your baby especially for the first 6 months, however sharing a room should not be confused with sharing a bed. Placing your baby to sleep on a separate surface such as a camp cot or Moses basket next to your bed is the safest place for them. It is also important that you do not fall asleep with your baby if you are on a couch or chair as this increases the risk of falls, suffocation, entrapment etc.
B IS FOR BACK
The practice of placing your baby on their back for every nap and sleep has proven to reduce the risk of SIDS. The first thing that parent’s worry about when they hear this is the safest position for their baby to sleep is “won’t they choke if they vomit?” Babies have an automatic reflex which allows them to cough or swallow anything that comes up which helps them keep their airway open. If they were to vomit while on their tummy or side, there is a far greater chance that they would breath in or suffocate as they may not be able to move their heads to open their airway.
C IS FOR COT
In line with sleeping alone, your baby should sleep in their own cot with a mattress that is firm and flat as this helps reduce the chance of suffocation. Creating a safe sleeping environment also involves ensuring that there are no loose items such as duvets, blankets, pillows, sleep positioners or wedges, stuffed animals or bumpers as they also increase the risk of suffocation should your baby accidentally roll into them.
The safest cot for your baby is one that is empty, with only a firm, properly fitted mattress and fitted waterproof sheet. This includes not using any type of sleep positioners, inclined sleepers or wedges as they pose a large danger should your baby roll around while in one.
WHAT ARE THE SAFE 7?
The International La Leche League indicates that although most breastfeeding moms do not plan on sharing their bed with their baby, ultimately 60-75% will at some stage do so. While they acknowledge that this is not in line with most safe sleep practices, they also recognise the benefits that are associated with sharing a bed. Those who do so report that they get more sleep and experience positive benefits on their milk supply. But is this recommendation proven to be safe? To make this practice as safe as possible, they developed the Safe 7:
- You should be a non-smoker
- You should be sober and unimpaired by any type of medication or drugs
- You should be breastfeeding
- Your baby should be healthy and full-term
- Your baby should be on their back
- Your baby should be lightly dressed
- Both of you should be on a safe surface
The last point of the Safe 7 indicates that you and your baby should be on a safe surface. To ensure this, they have pointed out 3 areas which should be checked:
- Avoid these items as they can be a potential smothering risk:
- Couches, chairs or recliners.
- A soft or sagging mattress that could cause your baby to roll into you or prevent them from lifting their head to a safer place.
- Avoid spaces where your baby may get stuck such as spaces between mattresses, headboards and walls.
- Pets which sleep on the bed.
- Make sure your bed does not have any:
- Unused pillows
- Heavy blankets or duvets
- Stuffed toys
- Any items such as cords or strings nearby
- Check your bed for potential hazards:
- The distance from the bed to the floor.
- The landing surface i.e. carpet or tiles or side tables.
- Anything that is sharp or could poke or pinch.
What does the evidence say about ROOM-SHARING?
The American Academy of Paediatrics (AAP) developed the Safe Sleep ABC. They encourage sharing a room with your baby especially for the first 6 months, however, they discourage sharing a bed. Sharing your room with your baby allows you to respond quickly to your baby if they become distressed.
A large study of evidence from across Europe found that the risk of sudden infant death was significantly reduced when babies slept in the same room, but not the same bed, as their parent/s.
Placing your baby to sleep on a separate surface such as a co-sleeper, Moses basket, cot, or camp cot next to your bed is the safest place for them.
What does the evidence say about bed-sharing?
Studies have found that bed-sharing is the most common cause of sleep-related death in babies, with the highest rate in babies who are 4 months and younger.
Bed-sharing may disturb parents’ sleep less, as your baby is close to you which gives them a sense of security and reduces the amount of times they wake up during the night. However, an adult bed is not considered a safe sleep space for a baby due to various potential dangers.
In most cases, bed-sharing comes with an increased risk of suffocation, entrapment, overheating, injury, and an overall higher risk of SIDS (Sudden Infant Death Syndrome) for the baby.
Based on the evidence, the AAP are unable to recommend bed sharing under any circumstances. They recommend having your baby close by your bedside in a crib or bassinet will allow you to feed, comfort, and respond to your baby’s needs at night.
The AAP also stress that it is also important for parents, doctors, midwives, lactation consultants and other medical staff to know that the following factors increase the magnitude of risk when bed sharing:
More than 10 times the baseline risk of parent–infant bed sharing:
- Bed sharing with someone who is impaired in their alertness or ability to arouse because of fatigue or use of sedating medications (e.g., certain antidepressants, pain medications) or substances (e.g. alcohol, illicit drugs).
- Bed sharing with a current smoker (even if the smoker does not smoke in bed) or if the pregnant parent smoked during pregnancy.
- Bed sharing on a soft surface, such as a waterbed, old mattress, sofa, couch, or armchair.
5–10 times the baseline risk of parent–infant bed sharing:
- Term, normal weight infant aged <4 months old, even if neither parent smokes and even if the infant is breastfed. This is a particularly vulnerable time, so parents who choose to feed their infants aged <4 months old in bed need to be especially vigilant to avoid falling asleep.
- Bed sharing with anyone who is not the infant’s parent, including nonparental caregivers and other children.
- Preterm or low birth weight infant, even if neither parent smokes.
- Bed sharing with soft bedding accessories, such as pillows or blankets.
What makes bed-sharing so dangerous?
In addition, babies who sleep in traditional, Western-style adult beds have been shown to have a much higher chance of accidental suffocation, entrapment, entanglement, falling, and overheating.
WHAT RISK FACTORS INCREASE THE DANGERS OF BEDSHARING?
The risk of accidental suffocation, entrapment, strangulation, injury, or death while bedsharing increases substantially if the parent:
- Smokes cigarettes frequently
- Consumes alcohol frequently or before going to sleep
- Takes recreational drugs.
- Takes prescribed medicine to help them sleep
- Feels unusually tired.
- Feels unwell or is sick
- Takes medication that impairs alertness and judgement.
- Suffers from post-partum depression
The risk of Sudden Infant death Syndrome while bedsharing increases substantially if the baby:
- Was born prematurely.
- Was a low weight at birth.
- Can roll from back to stomach and stomach to back.
- Has been overdressed
- Is formula fed
- Underwent surgery shortly after birth
Is it safer to use a pod or sleep nest in my bed for bedsharing?
The CCPC issued guidance to consumers in 2022 warning of the potential dangers of baby nest/pods. This guidance follows a combined total of over 4,500 dangerous baby nests and baby sleep bags being recalled in Ireland between 2021-2022.
As of August 2021, a company producing boppy's/lounger pods has issued a recall in the US for 3.3 million of its Newborn Lounger baby pillows following the deaths of eight babies between December 2015 and June 2020.
"The official recall notice – issued by the Consumer Product Safety Commission in the US – notes that infants can suffocate if they roll, move or are placed on the lounger in a position that obstructs their breathing. Or if they roll off the lounger onto another surface, such as an adult’s pillow or soft bedding this could also obstruct breathing". -Which?
Using a baby nest or pod for sleep poses the following serious risks:
- Strangulation due to drawstrings or ribbons on certain styles of baby nests. Never introduce any kind of cords or strings into a baby’s sleep area.
- Choking can occur if the inner contents, stuffing or detachable parts were to become accessible to a baby.
- Suffocation can occur due to the sides of a baby nest which can be quite soft, similar to cushions or bumpers. Any gaps between the sides and base mattress can also cause a baby’s head to get trapped.
Are independent co-sleepers/bedside cots safe?
There are some co-sleeper cots that can be used next to your bed. Approved co-sleepers should have EN 716 approval. Many of these co-sleepers can be attached to your bed with straps.
Although there have been documented cases of deaths and injuries in babies using co-sleepers, according to the updated 2022 AAP recommendations, there is insufficient evidence for the AAP to fully recommend co-sleepers, but parents can choose to use a bedside sleeper (if it passes the relevant safety standards)
"The AAP can’t recommend for or against these products because there have been no studies that have looked at their effect on SIDS or if they increase the risk of injury and death from suffocation"
However, when using co-sleepers, there are still risks of the following:
- Blankets, pillows, and other bedding from the adult bed accidentally covering baby’s face.
- Babies can roll into the adult bed while the parent is sleeping increasing the risk of parents rolling onto and smothering the baby.
- Babies can get trapped in between the co-sleeper and the parents bed. The gap between the adult bed and the co-sleeper must be no more than 1cm.
Here are some guidelines for using a co-sleeper safely:
- Keep all bedding away from the co-sleeper
- Put the side of the co-sleeper up when you go to sleep
- Stop using the co-sleeper as soon as your baby can roll
- Make sure there is nothing in the co-sleeper except a firm mattress and fitted sheet (no positioners/blankets/bedding/toys)
- All co-sleepers should come with a strap to secure the co-sleeper to the parents bed- always use this strap exactly as stated in the manual
- Ensure there isn't a gap of more than 1cm between the parents bed and the co-sleeper
It is important to note that IT IS NORMAL for young babies wake and feed frequently in the night and this cannot be changed, as young babies are not capable of ‘learning’ to defer their needs and due to this around half of all parents will sleep with their baby at some point, be this planned or unplanned. While bed-sharing may have certain benefits such as encouraging breastfeeding and convenience during night feeds, there are no scientific studies demonstrating that bed sharing reduces SIDS. Conversely, there are studies proving that bed sharing actually increases the risk of SIDS
The safest proven way for your baby to sleep is on his/her back, in his/her own cot in your bedroom, for the first 6-12 months. This allows you to monitor your baby and attend to their needs quickly but also keep them as safe as possible while sleeping.